非恒定像差非球面人工晶状体植入术后近期视觉质量评价

Evaluation of short-term visual quality following implantation of unsteady aberration aspheric intraocular lens

背景白内障手术目前已经由单纯挽救视力的手术发展为屈光性手术，因此视力不再作为术后惟一的评价标准，目前研究更多的关注在术后的视觉质量上。非球面人工晶状体（IOL）通过降低人眼的球差提高视网膜的成像质量。目的研究超声乳化白内障摘出术联合非恒定像差非球面IOL植入术后3个月年龄相关性白内障患者的视觉质量。方法采用前瞻性病例对照研究设计，纳入单纯年龄相关性白内障患者30例42眼，分别植入XL-Stabi ZO型非球面IOL（ZO组，21眼）及球面IOL（ADAPT组，21眼）。术后3个月检查患者的裸眼视力，最佳矫正视力（BCVA），明、暗、低眩光、高眩光环境下的对比敏感度（CS），明暗不同背景亮度（5％、10％、25％、100％）下的对比度视力，3、4、5mm瞳孔直径下的眼球像差，调制传递函数（MTF）及客观调节力，对2个组间的测量指标进行比较，并利用多元线性回归分析法分析cs与球差均方根、彗差均方根和患者年龄之间的关系。结果术后3个月ZO组与ADATP组间患者的裸眼视力、BCVA及球镜度数的差异均无统计学意义（P〉0．05）。暗视环境下6、12、18cpd空间频率时，低眩光6cpd、12cpd空间频率时以及高眩光12cpd、18cpd时ZO组的cs值均明显高于ADAPT组，差异均有统计学意义（P〈0．05）。暗背景对比度为100％时以及亮背景5％对比度下ZO组的对比度视力均明显高于ADAPT组，差异均有统计学意义（t=20．217，P=0．000；t=4．568，P=0．039）。3、4、5mm瞳孔直径下ZO组球差（z4）值均小于ADAPT组，差异均有统计学意义（U=63．000，P=0．000；U=52．000，P=0．000；U=36．000，P=0．000）；3mm、4mm瞳孔直径下ZO组三叶草像差（z6）值与ADAPT组比较，差异无统计学意义（U=204．000，P=0．678；U=215．000，P：0．890），5mm瞳孔直径下ZO组三叶草像差（z6）值小于ADAPT组，差异有统计学意义（U=4．000，P=0．000）；3、4、5mm瞳孔直径下ZO组的彗差（z7、z8）值与ADAPT组比较差异均无统计学意义（Z7：U=156．000，P：0．159；U=196．000，P=0．538；U=199．000，P=0．587；Z8：U=163．000，P=0．148；U=214．000，P=0．870；U=143．000，P=0．061）。高阶像差下瞳孔直径为4mm时5、10、15、20cpd4个空间频率下ZO组MTF值均高于ADAPT组，差异均有统计学意义（P〈0．05）；高阶像差下瞳孔直径为5mm时10、20、25、30cpd5个空间频率下z0组MTF值明显均高于ADAPT组，差异均有统计学意义（P〈0．05）。ZO组术眼的客观调节力稍低于ADAPT组，但2个组之间的差异无统计学意义（t=0．003，P=0．954）。多元线性回归分析表明，暗视环境下的cs变化与球差相关（β=0．544，R^2=0．519，P=0．000），而与彗差和患者的年龄无关。结论超声乳化白内障摘出术联合非恒定像差非球面IOL植入后可减少术眼的球差，其视觉质量优于球面IOL植入眼。

Background Cataract surgery with replacement of the natural lens with an artificial intraocular lens（IOL） has developed into refractive surgery. Visual acuity is not the only evaluation criterion, but more focus has been put into the visual quality postoperatively. Aspherical IOL could improve the visual quality by decreasing the aspherical aberration. Objective This study was to investigate the short-term visual acuity, aberration alteration and clinical application of unsteady aberration aspheric IOL. Methods A retrospective case-controlled study was designed. Forty-two eyes of 30 patients with age-related cataract were included and divided into two groups.Phacoemulsification combined with unsteady aberration aspheric IOL implantation was performed in 21 cataractous eyes of the ZO group,and phacoemulsification combined with spherical IOL implantation in the other 21 eyes of the ADAPT group. Visual acuity, best corrected visual acuity （BCVA） , contrast visual acuity, spherical aberration of the whole eye,contrast sensitivity（CS） ,dare sensitivity,modulation transfer function（MTF） and apparent accommodation were measured three months after surgery. All the parameters were compared between the two groups. The correlation of CS with the root mean square of spherical aberration,root mean square of comatic aberration and age was analyzed by multiple linear regression analysis. Written informed consent was obtained from each patient prior to operation. Results No significant differences were found in unconnected visual acuity,BCVA and spherical degrees between the ZO group and ADAPT group 3 months after surgery（P〉0.05）. The CS value in the ZO group was significantly higher than that of the ADAPT group under scotopic background condition with spatial frequencies of 6,12,18 cpd,low glare the spatial frequencies of 6,12 cpd, as well as high glare with 12,18 cpd （P〈0.05）. Under a scotopic background with 100% contrast or a photopic background with 5% contrast, the contrast visual acuity of the ZO group was significantly higher than that of the ADAPT group （ t = 20. 217, P = 0. 000 ; t = 4. 568, P = 0. 039 ）. At pupil diameters of 3,4 and 5 mm,the Z4 value was significantly lower in the patients of the ZO group than that of the ADAPT group （ U = 63. 000, P = 0. 000 ; U = 52. 000, P = 0. 000 ; U = 36. 000, P = 0. 000 ）. However, no significant differences were seen in the Trefoil aberration （Z6）value at 3 mm and 4 mm of pupil diameter（ U= 204. 000, P = 0. 678;U = 215. 000, P= 0. 890）and coma aberration （Z7, Z8）value at 3,4 and 5 mm of pupil diameter between ZO group and ADAPT group（ Z7 ： U= 156. 000, P = 0. 159 ; U = 196. 000, P = 0. 538 ; U = 199. 000, P = 0. 587 ; Z8 ： U= 163. 000, P = 0. 148 ; U= 214. 000, P = 0. 870 ; U = 143. 000, P = O. 061 ）. When the pupil diameter was 5 mm, Z6 value was significantly lower in the patients of the ZO group than that of the ADAPT group （ U = 4. 000, P = 0. 000）. The higher-order aberration MTF was significantly elevated in the ZO group compared with the ADAPT group from 5 through 20 cpd at a pupil diameter of 4 mm（ P〈0.05 ） and 10,20,25,30 cpd at a pupil diameter of 5 mm（ P〈0.05 ）. A slightly lower objective accommodation was found in the ZO group compared with the ADAPT group without statistically significant difference（ t = 0. 003 ,P〉0. 05 ）. Multiple linear regression analysis showed that the change in CS was associated with the root mean square of the spherical aberration and IOL type （β = 0. 544, R^2 = 0. 519, P = 0. 000 ）rather than with the root mean square of the comatic aberration and age. aberration aspheric IOL implanted eye is superior to spherical aberration. Conclusions The postoperative visual quality in the unsteady that in the spherical IOL implanted eye due to a reduction in